| Objectives:The clinical efficacy and safety of stable exertional angina pectoris in elderly patients with coronary heart disease( shenxu xueyu type) treated by acupuncture combined medication.Preliminary discuss the possible mechanisms of ischemic myocardial collateral circulation of the acupuncture, provide reference for clinical treatment of acupuncture and moxibustion.Methods:Selected 120 patients with elderly patients with coronary heart disease stable exertional angina pectoris( shenxu xueyu type) from April 2014- April 2015. Aged 60 ~ 80 years old, average(69.64±10.25) years. Divided into the treatment group and the control group(n = 60), according to random number table method. The control group given conventional western medicine treatment;Treatment group given acupuncture Shènshū(BL23)、Géshū(BL17)、Xīnshū(BL15)、Nèiguān(PC6), on the basis of the control group, 1 times a day, four weeks is one period of treatment. Observed the angina pectoris attack situation, resting electrical performance, traditional Chinese medicine symptom integral,result of 6 minutes walk test(6 MWT) and functional independence rating scale(FIM) to assess the patient’s heart function and exercise tolerance, the change of functional independence, daily life and record adverse events;At the same time, detection the peripheral blood endothelial progenitor cells(EPCs) and vascular endothelial growth factor(VEGF) level.Results:(1) 8 patients fall off or termination of the experiment, the final total of 112 cases of patients completed the test, the treatment group 56 cases, control group 56 cases. The baseline such as gender, age, course of the disease, cardiac function of the two groups before treatment has no statistically significant difference(P > 0.05).(2) The angina symptoms, resting electrocardiogram and traditional Chinese medicine symptom integral improved, has obtained the good curative effect.After intervention, the overall effect of the observation group was obviously superior to the control group, the difference has statistical significance(P < 0.05).(3) The 6 MWT results of the observation group of patients after treatment was longer than the before the treatment(456.49 ± 53.32) m vs(321.27 + 45.27) m, the difference had statistical significance(P < 0.05). The 6 MWT results of the control group patients before and after treatment has no statistically significant difference(P > 0.05).The 6 MWT results of the observation group of patients after treatment was significantly longer than the control group, the difference was statistical significance(P < 0.05).(4) The FIM score of the two groups of patients after treatment was significantly improved, and the difference had statistically significance(P < 0.05). The FIM score of the observation group after treatment was significantly higher than the control group, the difference was statistically significant(P < 0.05).(5) The peripheral blood EPCs and VEGF levels of the observation group of patients after treatment was significantly elevated, the difference had statistically significant(P < 0.05).While the peripheral blood EPCs and VEGF levels of the control group after treatment had no statistically significant difference compared with before treatment(P > 0.05).(6) The FIM scores and peripheral blood EPCs levels were significantly associated with 6 MWT of the observation group, positively correlated(r = 0.763, 0.654, P < 0.05).(7) The adherence of the two groups of patients are also good, 2 cases of the treatment group faintng during acupuncture treatment,but did not affect the treatment, 1 case of patients had subcutaneous hematoma, hematoma absorption after 7d.The blood routine, liver and kidney function of the two groups before and after treatment not seen obvious abnormity.Conclusions:(1) Acupuncture therapy can improve the angina attack situation, resting electrocardiogram(ecg), improve the stable exertional angina pectoris clinical curative effect of drug treatment in patients with stable exertional angina pectoris.(2) Acupuncture and medicine combination therapy can effectively improve cardiac function in patients with stable exertional angina and exercise tolerance, can improve the functional independence of daily life, can improve patients’ quality of life, easing the burden on the family and society, help patients return to society better.(3) Acupuncture and medicine combination therapy for stable exertional angina pectoris is safe and effective, has the good social and economic value, worthy of clinical promotion.(4) Acupuncture may mobilized the EPCs bone marrow into the peripheral blood, and improve the level of VEGF, prompting ischemic myocardial collateral circulation formation, may be the mechanism for the treatment of stable exertional angina. |
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